Mental Health Service Access in Arizona: A Qualitative Examination of Ecological Impacts for the Latinx Population

Abstract

Latinx persons experience mental health needs at rates similar to White individuals; however, they do not have the same utilization rates as their White counterparts. Research has indicated that multiple logistical factors go into this underutilization, such as lack of insurance coverage, transportation, or English-language skill proficiency; however, structural realities like culturally relevant components, provider biases, or a clinic’s atmosphere are not discussed within the context of the workers and the organization in which they practice. The three papers in this dissertation seek to understand the influence of external forces onto- and -within mental health organizations that deliver services to the Latinx community in Arizona. The primary aim of this qualitative study is to understand what factors influence access, how power is practiced through the delivery of access, and how the workers within mental health organizations interpret their function within that system and how they interact with their Latinx clients.Semi-structured interviews with 18 administrators (n=10) and direct service workers (n=8) were conducted throughout 2020 during the COVID-19 pandemic through online meetings or via telephone. Using the theoretical framework as a guide—a combination of ecological theory, critical race theory, and the power relation perspective--transcripts were coded with a focus on the relationships of power and environment within the organization. In navigating internal organizational policy, administrators more than direct service workers spoke of the limitations of funding, community collaboration, and the reputation of their organization within the large environment. In terms of navigating access that is culturally relevant for the Latinx population, the majority of participants identified Spanish language resources, while only a few (primarily administrators) spoke of how to create access through implementing broader cultural components. Results also indicate that individuals felt supported to make decisions within their organizations in how they work with the Latinx community, with descriptions of empowerment and power-sharing. Recommendations for policy, practice, and community partnerships are discussed.